Provider Demographics
NPI:1750650958
Name:PATHAK, PRAGNA ANIL (RPH)
Entity Type:Individual
Prefix:MRS
First Name:PRAGNA
Middle Name:ANIL
Last Name:PATHAK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-3508
Mailing Address - Country:US
Mailing Address - Phone:219-949-1055
Mailing Address - Fax:
Practice Address - Street 1:2500 GRANT ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-3508
Practice Address - Country:US
Practice Address - Phone:219-949-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019759A183500000X
IL051.292871183500000X
GA018017183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist